Adopt E-prescribing for Monetary Incentives
By Rhonda Buckholtz,CPC, CPC-I, CGSC, CPEDC, COBGC, CENTC
By now, you’ve probably heard the Centers for Medicare & Medicaid Services (CMS) will offer incentives to physicians who adopt electronic prescribing (e-prescribing). What you may not know is how easy it is to become involved.
E-prescribing transmits prescription or prescription-related information from the prescribing physician (or other qualified professional) to the dispenser and pharmacy benefit manager or health plan using electronic media. The process may occur directly or by way of an intermediary system (an e-prescribing network).
CMS supports e-prescribing in a big way: “Developing the standards that will facilitate e-prescribing is one of the key action items in the government’s plan to expedite the adoption of electronic medical records and build a national electronic health information infrastructure in the United States.” (www.cms.hhs.gov/eprescribing/)
Eligible professionals who successfully meet e-prescribing requirements for professional services, covered under Medicare Part B and provided during the reporting period, will receive bonus payments equal to 2 percent of the total estimated charges for those services.
If you’re not already e-prescribing, now’s the time to get involved. You’ll enjoy the advantages of improved productivity and patient care. 2009 and 2010 are the only two years participants can qualify for the full 2 percent incentive. In 2011 and 2012, the financial incentives from CMS will fall to 1 percent of your total estimated charges for covered professional services. In 2013, the incentive will decrease further to 0.5 percent.
The e-prescribing initiative is part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). CMS published its final rule for e-prescribing in the April 2, 2008 Federal Register.
The final rule provides three electronic tools for use in e-prescribing:
Formulary and benefit transactions: Gives prescribers information about which drugs are covered by a Medicare beneficiary’s prescription drug benefit plan.
Medication history transactions: Provides prescribers with information about medications a beneficiary is already taking, including those prescribed by other providers, to help reduce the occurrence of adverse drug events.
Fill status notifications: Allows prescribers to receive an electronic notice from the pharmacy telling them if a patient’s prescription has been picked up, not picked up, or partially filled, to help monitor medication adherence in patients with chronic conditions.
Note that the e-prescribing reporting measures are separate from and independent of the Physician Quality Reporting Initiative’s (PQRI) reporting measures. This means physicians may have a chance to receive two incentive payments: one for being a successful e-prescriber, and another for successfully submitting other PQRI measures. You do not have to participate in PQRI to participate in the e-prescribing incentive program.
How to Get Involved
There is no sign-up or pre-registration to participate in CMS’ e-prescribing incentive program, but you must meet the following requirements:
1. You must be an “eligible professional.” CMS defines an eligible professional as a:
- Physical or occupational therapist
- Qualified speech-language pathologist
- Nurse practitioner
- Physician assistant
- Clinical nurse specialist
- Certified registered nurse anesthetist
- Certified nurse midwife
- Clinical social worker
- Clinical psychologist
- Registered dietitian
- Nutrition professional
- Qualified audiologist
2. You must report one e-prescribing measure in at least half (50 percent) of the cases in which the measure is reportable during 2009.
CPT® and HCPCS Level II G codes reportable under the e-prescribing initiative include 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, G0101, G0108, and G0109.
You can find the complete eligible codes list for the e-prescribing initiative on the CMS website.
3. Your estimated allowable Medicare Part B charges for the e-prescribing measure codes must equal at least 10 percent of the total Medicare Part B charges allowed.
For example: If your estimated allowable Medicare Part B charges equal $100,000, at least $10,000 of these charges must be based on the codes included in the e-prescribing incentive program measure.
4. You must use a qualifying e-prescribing system. There are two systems for e-prescribing: a stand-alone system, or an electronic health record (EHR). Either of these may qualify, as long as it can:
- Generate a complete medication list that incorporates data from pharmacists and benefits managers (if available).
- Select medications, transmit prescriptions electronically using standards and warn the prescriber of possible undesirable or unsafe situations.
- Provide information on lower-cost, therapeutically appropriate alternatives (if available).
- Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan.
5. Prescriptions must be sent electronically. If the pharmacy converts the e-prescription into a paper fax because it cannot receive electronic faxes, the physician or other qualified professional still receives credit for e-prescribing. If your office has a system that is only capable of faxing to a pharmacy, however, you will not qualify for e-prescribing incentives.
6. You must report an appropriate numerator code (indicated below) in addition to a qualifying CPT® or HCPCS Level II G code on the claim you submit to Medicare.
If all of the prescriptions generated for the patient were sent via a qualified e-prescribing system, report G8443 Used a qualified e-prescribing system for all of the prescriptions.
If no prescriptions were generated for the patient during the visit, report G8445 Had a qualified e-prescribing system but didn’t generate any during this encounter.
If some or all of the prescriptions generated for the patient during the visit were printed or phoned in as required by state or federal law or regulations due to patient request or due to the pharmacy system being unable to receive electronic transmission, or because they were for narcotics or other controlled substances, report G8446 Had a qualified e-prescribing system but prescribed narcotics or other controlled substance; State or Federal Laws required you to phone in or print the prescriptions; The pharmacy system could not receive electronic transmissions.
7.You must submit all claims no later than two months after the reporting period ends. For services provided in 2009, claims must be submitted prior to February 2010.
Remember, the sooner you participate in the e-prescribing initiative, the greater your benefit. For additional information and complete instructions on e-prescribing initiative participation, visit the CMS Web site at: www.cms.hhs.gov/partnerships/downloads/11399.pdf.
Rhonda Buckholtz, CPC, CPC-I, CGSC, CPEDC, COBGC, CENTC, is AAPC’s liaison, director of business and member development.